1. The document discusses irritable bowel syndrome (IBS), noting that it is a common disorder affecting the large intestine that causes abdominal pain, bloating, gas, diarrhea and constipation. 2. The author provides a new explanation for IBS, arguing that it is caused by periodic portal infection through an ulcer in the cecum or ascending colon, which allows bacteria to proliferate and circulate toxins. 3. Through detailed examination of patients, the author determined that restricting diet can help curb or terminate portal infection and its associated IBS symptoms.

1. * Corresponding author: D.N.Tripathi
E-mail address:drdntripathi@gmail.com 264
IJAMSCR | Volume 2 | Issue 3 | July-Sep - 2014
www.ijamscr.com
Review article
Some new facts on irritable bowel syndrome.
D.N.Tripathi.
Ex-Principal & Head of Surgery Dept, SCB Medical College, Cuttack, Odisha-753007.
ABSTRACT
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon). Irritable bowel syndrome
commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will
need to manage long term. Irritable bowel syndrome, is a disorder of the intestine that carries no structural lesions or
pathophysiological explanations. Between 10 and 20% of the population in developed countries suffer from IBS, with almost
75% of those people reporting symptoms being female. While IBS is a widespread condition, only 20-30% of sufferers
consult a doctor.
Key words: Irritable bowel syndrome (IBS), Intense vagal activity, Spastic segment.
INTRODUCTION
We deal with one of the disease that has evaded all
efforts in the past to unfold its secrets, as a result of which
a patient had benefited very little on the advice and
treatment detailed out to him from time to time. Various
authors have given different definitions from time to
time. With a diseased liver most of the drugs prescribed
turned out to be toxic and undesirable. Sometimes they
are very toxic with side effects for which the drug must
be banned. We shall discuss here the salient features of
our studies since 1947 when we came across the first
case. It took the author 65 years to find out that
periodical attacks of a very severe nature was due to
portal infection through an ulcer at the ileo-cecal junction
in the cecum or in the ascending colon that became
excessively tender and inflamed at times actively. After a
few days the ulcer returned to a dormant state, tenderness
disappears and the channel through which portal infection
moves upwards gets blocked, at least for a short period
with misfortunes coming to a sudden end. An intelligent
micro-biologist pointed out that during the very active
stage of the disease, in the low power microscope, the
bacterial count in the stool was very high, never found in
good health. The disease and dysfunction of liver create
all the woes when a segment of the colon had a partial
healed ulcer of the past. A few cases are definitely
ischemic with spasticity and functional periodical
obstruction. We have given here a new explanation to all
these facts in a scientific way to clear the confusion that
haunts us. I have made it clear that closing the Gate is
not an easy matter to deal with. Limiting the quantum of
food to two meals a day with a small amount of non-
residual diet, may sometimes succeed. One must restrain
and never take frequent diets one after another to
stimulate an uncalled for sudden peristalsis termed
specially by the author as an “Ejection Phenomena”. We
also explained that this condition should not be confused
with ‘POOL diarrhea” which is actually a bacterial soup
and stale food, lying dormant in the shape of a small
quantity of bacterial emulsion, of the previous 2 days
forcibly evacuated out when its liquid mass increases in
volume and toxicity.7,8,9,10
International Journal of Allied Medical Sciences
and Clinical Research (IJAMSCR)

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The word IBS came to the medical scientific use in 1950
though its occurrences were few and far between. Till
then the condition was also known as Chronic colitis .
The underlying mechanism was never understood by any
clinician in the past, the question of Portal Infection was
never thought of in IBS. 1,2,3
There was no progress till a colleague pathologist of mine
pointed out the author that he was dealing with two
different types of stools in the same patient, once the
bacterial count was very high under low power which
his friend pointed out as grossly abnormal while at other
times of normal health it was far less so. Detail
examination of the abdomen periodically for tenderness at
the suspected site of ulcer in the cecum and aspiraton of
bile through the Ryle’s tube followed by examination of
stool convinced him in July 15, 2013 that portal infection
periodically was the real culprit. Auscultation of the
cecum during an attack convinced him that infected food
passing through that segment produces mild pain and
discomfort never found in normal health in the same
patient at other times.4,5,6.
Minute and detail examinations
periodically day and night on three or four cases for three
years brought out all the truth regarding Portal infection
and its periodical appearance by the middle of July 2013.
Associated factors like mild hepatitis, loss of appetite and
apathy convinced him that portal infection alone was the
constant culprit each and every time of such short lived
events when restriction of diet also restricts the duration
and severity of portal infection. Moreover when the diet
is non-residual or restricted to small amounts and long
intervals between two adjacent meals portal infection can
be curbed or terminated for the time being. Of course
fulminant infections in the gut are difficult to control
when bile is heavily infected and need one or more drugs
to control the same, like metronidazole 400 tds.
The past history of IBS has passed through many stormy
events due to fulminant infection inside the gut. There
has been a lot of confusion among clinicians as to how
and why some symptoms appear and then disappear
without any trace and without any reason. It is of course
ridiculous to think that those abnormal symptoms will
only appear in persons with a psychosomatic trait. In that
case we shall have to believe that dysenteric ulcers in the
gut are prone to develop only in the psychosomatic state,
which he had inherited in the past and not otherwise. We
have found that these persons take food more than three
times a day when their liver cannot cope with heavy
meals or fatty food unfit for the particular person both in
quality and quantity, while a lot of half digested food
stagnates in the gut for lack of bile and pancreatic juice
that are heavily infected,thus allowing various bacteria to
proliferate and generate some amines and chemicals to
circulate in the blood and generate bizarre symptoms of
intolerance. So much so that one of my patients found it
imperative to drive a car or a motor cycle at a far higher
speed than normal imperiling his life and safety limits on
the road. Behind all this Portal infection was the real
cause the abnormal state and duration of that state due to
liver disease and stagnation of food inside the gut that was
unfit for assimilation and utility. Lack of Hydrochloric
acid in the stomach should be investigated and food
acidified with lemon juice or vinegar in cut tomatoes
encouraged to prevent destruction of taken HCl by some
alkaline food materials. Many of my patients use the
following meals daily twice as a routine. :--
1. 2 to 4 toasts very lightly baked to partly dehydrate it
for digestion. Some take only one.
2. Fish curry with gravy sweetened by tomato
sauce,30-50 grms.fish once.
3. Half cup non-fat yogurt,corn flakes and sugar, a lot
of it.2-3 tsp.
4. A cup of boiled potatoes with spinach,tomatoes
with lentil or corn soup
Two such meals a day with some sweet fruit juice.
5, Fermented Bengal gram(Black gram) balls fried and
ropped into salted yogurt.
Key Words:--Ulcer cecum; “Gate Theory”; Right Hemi-
colectomy; Bacterial count in the low power of
microscope; Infection of the portal ducts and portal vein;
attacks of acute IBS periodically; infection of bile and
pancreatic juice; liver function and liver damage.
;‘Ejection phenomena’ when a forceful bowel movement
and diarrhea occur just after a normal meal; spasm of a
small segment in the colon just distal to the ulcer;
ischemia of a segment of colon, achlorhydria, Heidelberg
pH capsules to swallow to estimate gasric pH on the radio
monitor outside body, “Pool”diarrhea. 11,12,13,14
IS IT A PSYCHOSOMATIC DISEASE ?
See what some clinicians said about it since a long time
earlier. Open up the internet and read some chapters,
which are not clearly convincing and are incorrect. Many

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people with irritable bowel syndrome do suffer
frequently and intensely from anxiety or depression, some
people believe IBS to be a purely psychological disorder.
In reality, irritable bowel syndrome stems from a
breakdown in the interactions between the central
nervous system and the nervous system of the bowels due
to reaction of various chemicals and amines that circulate
in the body, these chemicals being produced by the
intestinal bacteria in massive quantities periodically,
only from the stale nutrients absorbed from the gut along
with toxic chemicals that those bacteria generate.
Gradually the body adjusts and fails to react to those
toxins and chemicals after some months or years
depending on the degree and virulence of infecting
bacteria. This can be ameliorated by frequent heavy doses
of Metronidazole(M-400) for experimental purposes only
to prove my theory here. Previously I had named it Psedo-
Botulism of IBS. Irritable Bowel Syndrome is or is not a
disease ? Is it a functional disorder, named in
Internet.which means that the bowel simplydoes not work
as it should. Irritable Bowel yndrome was characterized
as a “brain-gut dysfunction”. We have to drop these.
It is difficult to understand how amoebic dysentery can
bring in a psychopathic state in a patient when some one
in the past also branded these patients to have ‘Gene’
defects. These are all wrong ideas that ruled the medical
practitioners for over 70 years in the past. And now some
people do not want to give up all the previous ideas and
various terms of their own imagination. 15,16,17
However one must understand that:—
(a). This abnormal state occurs periodically at the end of
the digestion when the patient is suffering from fulminant
portal bacteremia with infected bile and the entire gut
filled with various amines and chemicals generated by a
host of foreign organisms that have now multiplied inside
the gut and also in the portal vein, bile and liver.
(b). M-400 with an added antibiotic orally will
successfully prevent such a mental state if food intake is
restricted to ones capacity and overeating prevented with
a non-residual nutritious diet.
(c). Foods that are quickly digested and never stagnate for
a long time in the gut will successfully prevent such
attacks and portal infection.
(d). Such a condition will never occur when portal
bacteremia is absent during all those intervals when the
disease is in the interval of a quiet state with normal
digestion.
(e). Smaller amounts of non-residual foods will never
generate such a psychic state when carefully spaced to
prevent stagnation in the gut. This is a very important
fact.
In the end I would like to state that stagnation of infected
food generate various chemicals and amines that are
absorbed into the blood through the portal vein into the
general circulation while the diseased liver is unable to
detoxicate these chemicals.
IBS is DEFINED as the aftermath of a severe dysentery
infection that opens up periodically a “Gate” from inside
the gut, for the infection to spread into the portal system,
the liver and the biliary tract with reactions in different
parts of the body, for a length of time. The infecting
agents are the colon bacteria and their metabolic
products. The cause and mechanism of this amazing
disease was misunderstood for over seventy years or
more in the past, primarily due to reactions of the human
body to various different chemical agents including the
hyaluronidase, produced only by amoeba which is its sole
armor. This highly diffusible enzyme is powerful enough
to attack a tissue where the cells are held together in an
orderly fashion by delicate intercellular fibrous tissue
cells. Hydase passes and diffuses out in between the cells
that dissolves this fibrous matrix. Shower of cells drop
down below into the inflammatory fluid when they lose
their supportive tissues that held them together and
starves them to death due to lack of nutrition. Most likely
it is Hydase opens up a Gate and a path the same way it
moves up. One must estimate the pH of HCl in stomach
by Fractional Test Meal or swallow a Heidelberg pH
capsule with a Radio-monitor outside the abdomen to
measure it,periodically. Before taking HCl take a few cut
tomatoes in vinegar to neutralize all alkali foods and
make it faintly acidic. Then only take N/10 HCl 2-6 ml ,
adding 60 ml water to it at the end.18,19,20,21,22,23
WHAT DOES A SPASTIC SEGMENT INDICATE ?
A physician explains it as “Intense vagal activity” and
slower heart-rate but it is actually the beginning of
anIschaemic Segment. Mostly this segment is confined to
the right side, proximal half of colon. Powerful drugs like
Buscopan or Antrenyl can give a temporary relief, if at
all. Watch carefully for 3 years before deciding on resection of a small segment as advised.24,25,26,27

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5. There are devices which test the sufficiency of oxygen delivery to the colon. The first device approved by the U.S. FDA in
2004 uses visible light. Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate
diagnosis such as infection or inflammatory bowel disease. Spectroscopy will help to analyze capillaries. Endoscopic
exam.ivia colonoscopy or flexible sigmoidoscopy, is the procedure of choice. Biopsies can be taken via endoscopy to
provide more information. Visible light
spectroscopy, performed using catheters placed through the 5 mm channel of the endoscope, is diagnostic of artery oxygen
levels. The palor of a segment of colon and its inability to function as a conveyer.with persistent rigidity and functional
obstruction always indicate that the particular segment of the colon is a definite misfit for normal health.
6. There are some rare conditions not related to IBS
Acute partial Budd-Chiari syndrome, cytomegalovirus infection as a cause of acute portal vein thrombosis.
Fusobacteriumnecrophorum infection
Primary sclerosingcholangitis.Pulmonary embolism and portal vein thrombosis, Infection pylephlebitis of portal vein,primary
biliary cirrhosis.
Since 1947 I had been treating IBS empirically in small numbers as most cases go to physicians but my observation was
long in each case and a thorough palpation of the periodic lump in the cecum, waxing and waning. Very tender and bigger
periodically with gross infection they seemed to me abnormal. In 1972-73 I read how John Goligher had resected and cured
some cases of localized ulcers of a small segment of the colon and cured them. Now I must follow the same path in some
three cases and a fourth one by performing Right Hemicolectomy in 1973 which was very simple and safe and waited for
biopsy reports. The ulcers were ghastly indurated with a simple ulcer but gross base infiltration, palor and fixitynever to heal
in future. I stopped further as waited as I was in ill health. Two of my students were deputed to Leeds to meet Goligher and
discuss my latest subject. He invited me again in1978 when he had retired but due to some constraints I could not go out. He
fed my messengers Bengal gram lentil fermented balls in curd and whey (Daw-e-baw-da in Hindi) as a great Indian food. I
waited to watch further when in July 2013 I announced the Portal Infection theory of my own and advised some to do an
ERCP in some cases of IBS and collect some bile in a retrograde canula through the Ampula of Vater to establish my
theory. Four of my operated cases were above 60 where IBS had disappeared forever but the liver damage is recovering very
slowly. Some food restriction is of their own choice and I have to give them only Pancreatic enzymes and fruit juices. In
three of them the distal part of the colon was very pale and fibrous due likely to Ischemia.
We have just started a new experiment with Tinidazole-500 instead of Metronidajole-400 in future. The first tablet of T-500
was given 10 days age when there was marked tenderness of Cecum and Ascending colon lower part. All went well for 10
days and previous pain cecum and lower half ascending colon came back 10th day evening. On 10th night we gave a second
tablet of T-500 which worked wonders with increased urine secretion and disappearance of all pain much better than due to
M-400 of previous occasions. This research will be continued with only T-500 now and no more with M-400 in the future for
about 3-4 months when we shall publish again.
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[25]New Discovery on the causes of IBS and Flatus by Prof D.N.Tripathi, Published by self
July 2013.
[26]Recent advances & clinical studies on IBS ..published as above by Prof.D.N.Tripathi
[27]New Facts Discovered in IBS by Prof.D.N.Tripathi..Published as above.